Firstl it said the additional £1.6bn announced by the government for 2018-19 is less than was requested by NHSE at the time of the Five Year Forward View settlement in 2015 – which appears to directly contradict the chancellor’s budget statement, in which he said the NHS’s funding ask had been “met”.

Because of the shortfall, it added “the NHS will likely not be able to do everything being expected of it”.

If the elective waiting time standard is to be met, NHSE said, cuts would need to be made to other services such as mental health, cancer, and primary care.

So over to you, Theresa May, which is it going to be?

For several years, NHS lobby groups, think tanks and accountants have warned that the time for difficult choices (or increased taxes) had come, and Simon Stevens has been hinting at it for many months.

But by standing up and saying it so clearly and publicly, the independent NHS (since 2012) has sailed into uncharted territory.

It feels like a defining moment, perhaps for both the government and the NHS, and one from which it will be impossible for both sides to walk away unscathed.

Move closer

At NHS Improvement’s board meeting, Baroness Harding revealed she was keen to collaborate more with NHS England and she would be ringfencing a small team of people to work with the national commissioning board to consider what the two bodies can do together and separately.

The news could mean more joint appointments, the odd shared board meeting, but no full merger.

Legal advice to NHS England has made clear the organisations cannot merge or share a CEO or chair without primary legislation being passed and there is no prospect of that in the near future.